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Christiansen SD, Liu J, Bullrich MB, Sharma M, Boulton M, Pandey SK, Sposato LA, Drangova M. Deep learning prediction of stroke thrombus red blood cell content from multiparametric MRI. Interv Neuroradiol 2022:15910199221140962. [PMID: 36437762 DOI: 10.1177/15910199221140962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND AND PURPOSE Thrombus red blood cell (RBC) content has been shown to be a significant factor influencing the efficacy of acute ischemic stroke treatment. In this study, our objective was to evaluate the ability of convolutional neural networks (CNNs) to predict ischemic stroke thrombus RBC content using multiparametric MR images. MATERIALS AND METHODS Retrieved stroke thrombi were scanned ex vivo using a three-dimensional multi-echo gradient echo sequence and histologically analyzed. 188 thrombus R2*, quantitative susceptibility mapping and late-echo GRE magnitude image slices were used to train and test a 3-layer CNN through cross-validation. Data augmentation techniques involving input equalization and random image transformation were employed to improve network performance. The network was assessed for its ability to quantitatively predict RBC content and to classify thrombi into RBC-rich and RBC-poor groups. RESULTS The CNN predicted thrombus RBC content with an accuracy of 62% (95% CI 48-76%) when trained on the original dataset and improved to 72% (95% CI 60-84%) on the augmented dataset. The network classified thrombi as RBC-rich or poor with an accuracy of 71% (95% CI 58-84%) and an area under the curve of 0.72 (95% CI 0.57-0.87) when trained on the original dataset and improved to 80% (95% CI 69-91%) and 0.84 (95% CI 0.73-0.95), respectively, on the augmented dataset. CONCLUSIONS The CNN was able to accurately predict thrombus RBC content using multiparametric MR images, and could provide a means to guide treatment strategy in acute ischemic stroke.
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Affiliation(s)
- Spencer D Christiansen
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, 6221Western University, London, Ontario, Canada
| | - Junmin Liu
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Maria Bres Bullrich
- Department of Clinical Neurological Sciences, 6221Western University, London, Ontario, Canada
| | - Manas Sharma
- Department of Medical Imaging, 6221Western University, London, Ontario, Canada
| | - Melfort Boulton
- Department of Clinical Neurological Sciences, 6221Western University, London, Ontario, Canada
| | - Sachin K Pandey
- Department of Medical Imaging, 6221Western University, London, Ontario, Canada
| | - Luciano A Sposato
- Department of Clinical Neurological Sciences, 6221Western University, London, Ontario, Canada
| | - Maria Drangova
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, 6221Western University, London, Ontario, Canada
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2
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LaGrange DD, Wanke I, Machi P, Bernava G, Vargas M, Botta D, Berberat J, Muster M, Platon A, Poletti PA, Lövblad KO. Multimodality Characterization of the Clot in Acute Stroke. Front Neurol 2022; 12:760148. [PMID: 34970209 PMCID: PMC8712945 DOI: 10.3389/fneur.2021.760148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/17/2021] [Indexed: 11/26/2022] Open
Abstract
Aim: Current treatment of occluded cerebral vessels can be done by a variety of endovascular techniques. Sometimes, the clot responds in varying degrees to the treatment chosen. The Ex vivo characterization of the clot occluding the arteries in acute ischemic stroke can help in understanding the underlying imaging features obtained from pre-treatment brain scans. For this reason, we explored the potential of microCT when combined with electron microscopy for clot characterization. Results were compared to the clinical CT findings. Methods: 16 patients (9 males, 8 females, age range 54–93 years) who were referred to our institution for acute stroke underwent dual-source CT. Results: Clinical CT clots were seen as either iso or hyperdense. This was corroborated with micro-CT, and electron microscopy can show the detailed composition. Conclusion: MicroCT values can be used as an indicator for red blood cells-rich composition of clots. Meaningful information regarding the clot composition and modalities of embedding along the stent retrievers can be obtained through a combination of microCT and electron microscopy.
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Affiliation(s)
- Daniela Dumitriu LaGrange
- Division of Diagnostic and Interventional Neuroradiology, Diagnostic Department, HUG Geneva University Hospitals, Genève, Switzerland
| | - Isabel Wanke
- Division of Neuroradiology, Zentrum für Neuroradiologie, Klinik Hirslanden, Zurich, Switzerland.,Swiss Neuroradiology Institute, Zurich, Switzerland.,Division of Neuroradiology, Institute of Diagnostic and Interventional Radiology and Neuroradiology, University of Essen, Essen, Germany
| | - Paolo Machi
- Division of Diagnostic and Interventional Neuroradiology, Diagnostic Department, HUG Geneva University Hospitals, Genève, Switzerland
| | - Gianmarco Bernava
- Division of Diagnostic and Interventional Neuroradiology, Diagnostic Department, HUG Geneva University Hospitals, Genève, Switzerland
| | - Maria Vargas
- Division of Diagnostic and Interventional Neuroradiology, Diagnostic Department, HUG Geneva University Hospitals, Genève, Switzerland
| | - Daniele Botta
- Division of Radiology, Diagnostic Department, Geneva University Hospitals, Genève, Switzerland
| | - Jatta Berberat
- Division of Neuroradiology, Zentrale Medizinische Dienste, Kantonsspital Aarau, Aarau, Switzerland
| | - Michel Muster
- Division of Diagnostic and Interventional Neuroradiology, Diagnostic Department, HUG Geneva University Hospitals, Genève, Switzerland
| | - Alexandra Platon
- Division of Radiology, Diagnostic Department, Geneva University Hospitals, Genève, Switzerland
| | | | - Karl-Olof Lövblad
- Division of Diagnostic and Interventional Neuroradiology, Diagnostic Department, HUG Geneva University Hospitals, Genève, Switzerland
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3
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Rossi R, Fitzgerald S, Gil SM, Mereuta OM, Douglas A, Pandit A, Brennan P, Power S, Alderson J, O'Hare A, Gilvarry M, McCarthy R, Psychogios K, Magoufis G, Tsivgoulis G, Szikora I, Jood K, Redfors P, Nordanstig A, Ceder E, Tatlisumak T, Rentzos A, Thornton J, Doyle KM. Correlation between acute ischaemic stroke clot length before mechanical thrombectomy and extracted clot area: Impact of thrombus size on number of passes for clot removal and final recanalization. Eur Stroke J 2021; 6:254-261. [PMID: 34746421 PMCID: PMC8564157 DOI: 10.1177/23969873211024777] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 05/15/2021] [Indexed: 01/01/2023] Open
Abstract
Introduction We assessed the correlation between thrombus size before and after mechanical
thrombectomy, measured as length by Computed Tomography
Angiography/Non-Contrast Computed Tomography (CTA/NCCT) and Extracted Clot
Area, ECA, respectively. We also assessed the influence of thrombus size on
the number of passes required for clot removal and final recanalization
outcome. Materials and methods Acute ischaemic stroke (AIS) thrombi retrieved by mechanical thrombectomy
from 500 patients and data of clot length by CTA/NCCT were collected from
three hospitals in Europe. ECA was obtained by measuring the area of the
extracted clot. Non-parametric tests were used for data analysis. Results A strong positive correlation was found between clot length on CTA/NCCT and
ECA (rho = 0.619,N = 500,P < 0.0001*). Vessel size influences clot length
on CTA/NCCT (H2 = 98.6, P < 0.0001*) and ECA (H2 = 105.6,P < 0.0001*),
but the significant correlation between CTA/NCCT length and ECA was evident
in all vessels. Poorer revascularisation outcome was associated with more
passes (H5 = 73.1, P < 0.0001*). More passes were required to remove
longer clots (CTA/NCCT; H4 = 31.4, P < 0.0001*; ECA; H4 = 50.2,
P < 0.0001*). There was no significant main association between
recanalization outcome and length on CTA/NCCT or ECA, but medium sized clots
(ECA 20–40 mm2) were associated with least passes and highest
revascularisation outcome (N = 500, X2 = 16.2,
P < 0.0001*). Conclusion Clot length on CTA/NCCT strongly correlates with ECA. Occlusion location
influences clot size. More passes are associated with poorer
revascularisation outcome and bigger clots. The relationship between size
and revascularisation outcome is more complex. Clots of medium ECA take less
passes to remove and are associated with better recanalization outcome than
both smaller and larger clots.
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Affiliation(s)
- Rosanna Rossi
- Department of Physiology and Galway Neuroscience Centre, School of Medicine, National University of Ireland, Galway, Ireland.,CÚRAM-SFI Research Centre in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Seán Fitzgerald
- Department of Physiology and Galway Neuroscience Centre, School of Medicine, National University of Ireland, Galway, Ireland.,CÚRAM-SFI Research Centre in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Sara M Gil
- Department of Radiology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.,Department of Radiology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Oana M Mereuta
- Department of Physiology and Galway Neuroscience Centre, School of Medicine, National University of Ireland, Galway, Ireland.,CÚRAM-SFI Research Centre in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Andrew Douglas
- Department of Physiology and Galway Neuroscience Centre, School of Medicine, National University of Ireland, Galway, Ireland.,CÚRAM-SFI Research Centre in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Abhay Pandit
- CÚRAM-SFI Research Centre in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Paul Brennan
- Department of Radiology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Sarah Power
- Department of Radiology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Jack Alderson
- Department of Radiology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Alan O'Hare
- Department of Radiology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | | | | | | | - Georgios Magoufis
- Metropolitan Hospital, Department of Neuroradiology, Piraeus, Greece
| | | | - István Szikora
- Second Department of Neurology, National & Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Katarina Jood
- National Institute of Clinical Neurosciences, Department of Neurointerventions, Budapest, Hungary
| | - Petra Redfors
- National Institute of Clinical Neurosciences, Department of Neurointerventions, Budapest, Hungary
| | - Annika Nordanstig
- National Institute of Clinical Neurosciences, Department of Neurointerventions, Budapest, Hungary
| | - Erik Ceder
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden, and Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Turgut Tatlisumak
- National Institute of Clinical Neurosciences, Department of Neurointerventions, Budapest, Hungary
| | - Alexandros Rentzos
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden, and Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - John Thornton
- Department of Radiology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Karen M Doyle
- Department of Physiology and Galway Neuroscience Centre, School of Medicine, National University of Ireland, Galway, Ireland.,CÚRAM-SFI Research Centre in Medical Devices, National University of Ireland Galway, Galway, Ireland
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4
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Mohammaden MH, Haussen DC, Perry da Camara C, Pisani L, Olive Gadea M, Al-Bayati AR, Liberato B, Rangaraju S, Frankel MR, Nogueira RG. Hyperdense vessel sign as a potential guide for the choice of stent retriever versus contact aspiration as first-line thrombectomy strategy. J Neurointerv Surg 2020; 13:599-604. [PMID: 32737205 DOI: 10.1136/neurintsurg-2020-016005] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/10/2020] [Accepted: 06/14/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND The first-pass effect (FPE) has emerged as a key metric for efficacy in mechanical thrombectomy (MT). The hyperdense vessel sign (HDVS) on non-contrast head CT (NCCT) indicates a higher clot content of red blood cells. OBJECTIVE To assess whether the HDVS could serve as an imaging biomarker for guiding first-line device selection in MT. METHODS A prospective MT database was reviewed for consecutive patients with anterior circulation large vessel occlusion stroke who underwent thrombectomy with stent retriever (SR) or contact aspiration (CA) as first-line therapy between January 2012 and November 2018. Pretreatment NCCT scans were evaluated for the presence of HDVS. The primary outcome was FPE (modified Thrombolysis in Cerebral Infarction score 2c/3). The primary analysis was the interaction between HDVS and thrombectomy modality on FPE. Secondary analyses aimed to evaluate the predictors of FPE. RESULTS A total of 779 patients qualified for the analysis. HDVS and FPE were reported in 473 (60.7%) and 286 (36.7%) patients, respectively. The presence of HDVS significantly modified the effect of thrombectomy modality on FPE (p=0.01), with patients with HDVS having a significantly higher rate of FPE with a SR (41.3% vs 22.2%, p=0.001; adjusted OR 2.11 (95% CI 1.20 to 3.70), p=0.009) and non-HDVS patients having a numerically better response to CA (41.4% vs 33.9%, p=0.28; adjusted OR 0.58 (95% CI 0.311 to 1.084), p=0.088). Age (OR 1.01 (95% CI 1.00 to 1.02), p=0.04) and balloon guide catheter (OR 2.08 (95% CI 1.24 to 3.47), p=0.005) were independent predictors of FPE in the overall population. CONCLUSION Our data suggest that patients with HDVS may have a better response to SRs than CA for the FPE. Larger confirmatory prospective studies are warranted.
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Affiliation(s)
- Mahmoud H Mohammaden
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Diogo C Haussen
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Catarina Perry da Camara
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Leonardo Pisani
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Marta Olive Gadea
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Alhamza R Al-Bayati
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Bernardo Liberato
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Srikant Rangaraju
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Michael R Frankel
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Raul G Nogueira
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA .,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA
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5
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Lövblad KO, Bouchez L, Altrichter S, Ratib O, Machi P, Vargas MI, Sztajzel R. The role of advanced neuroimaging techniques in ischemic stroke prevention. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2019. [DOI: 10.1177/2514183x19881446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
In great part due to recent advances in medical technology, ischemic cerebral stroke has become an increasingly treatable condition, which requires urgent measures and which rely on pharmacological and/or interventional measures. Due to its high prevalence, preventive measures should also be undertaken, and this is a situation where the use of advanced neuroimaging techniques could be helpful in certain underlying diseases. What is proposed here is to discuss how modern neuroimaging techniques (advanced magnetic resonance (MR) techniques and/or nuclear medicine techniques such as positron emission tomography (PET)) could help in situations that would otherwise lead to a stroke. Since both primary and secondary prevention measures are often required, we see that the techniques can be helpful in both situations. The diseases that cause stroke that can be investigated are, among others, carotid stenosis; transient ischemic attacks (TIAs) may also be followed by a major stroke if nothing is undertaken. It has been established that carotid stenosis is to be treated in the presence of a significant lesion that has neurological symptoms. The question of how to deal with these patients often arises when the relationship between the stenosis and symptoms is not significant or the symptomatology unclear. In such situations, either PET and/or fat-saturated T1 images of the carotids can help to demonstrate the embolic nature of the plaque. We have seen that carotid plaque vulnerability, which can cause embolism, can be associated with plaque inflammation (seen on PET) or plaque haemorrhage (seen on MR images). Also, while PET and MRI will demonstrate different stages of plaque vulnerability, they can both help to demonstrate vascular lesions that are at risk of causing significant ischemic events. Diffusion-weighted imaging (DWI) has shown that some TIAs may indeed be ischemic brain lesions with a transient symptomatology. The early use of DWI can thus help treat these patients more acutely. Based on this, we have seen that newer imaging techniques can provide additional knowledge about conditions that may lead to stroke and be treated. This should have a major impact on patient outcomes and ultimately on healthcare costs related to this condition.
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Affiliation(s)
- Karl-Olof Lövblad
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Laurie Bouchez
- Division of Radiology, Geneva University Hospitals, Geneva, Switzerland
| | - Stephen Altrichter
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Osman Ratib
- Division of Nuclear Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Paolo Machi
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Maria Isabel Vargas
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Roman Sztajzel
- Division of Neurology, Geneva University Hospitals, Geneva, Switzerland
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6
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Imaging Clot Characteristics in Stroke and its Possible Implication on Treatment. Clin Neuroradiol 2019; 30:27-35. [DOI: 10.1007/s00062-019-00841-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/17/2019] [Indexed: 12/11/2022]
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7
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Affiliation(s)
- K-O Lövblad
- Division of Diagnostic and Interventional Neuroradiology Geneva University Hospitals Geneva, Switzerland
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